Why the study?
Atrial fibrillation increases the risk of stroke and systemic embolic events, prompting a comparison of real-world effectiveness and safety of edoxaban with other DOACs and VKAs in European patients with NVAF.
Do DOACs, specifically edoxaban, improve effectiveness and safety outcomes compared to VKAs and other DOACs in patients with NVAF in Europe?
Meta-Analysis
Yes
Do DOACs, specifically edoxaban, improve effectiveness and safety outcomes compared to VKAs and other DOACs in patients with NVAF in Europe?
Hazard Ratio: 0.67 (95% CI 0.54–0.84)
In a real-world European NVAF population, DOACs showed benefit over VKAs, and edoxaban demonstrated comparable effectiveness to other DOACs with significantly lower risks of major bleeding and intracranial hemorrhage compared to rivaroxaban.
AIM: Atrial fibrillation is the most commonly sustained cardiac arrhythmia, increasing the risk of stroke and systemic embolic events. This systematic review and network meta-analysis (NMA) aimed to compare real-world evidence (RWE) on the effectiveness and safety of edoxaban with other direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF) in Europe. MATERIALS & METHODS: Searches from January 2013 to December 2022 identified comparative observational studies assessing effectiveness/safety outcomes in patients with NVAF. Bayesian NMA estimated comparative effectiveness/safety of edoxaban with other DOACs and VKAs. RESULTS: The review identified 57 studies analyzing data from 24 unique databases; 33 studies were included in the base-case analyses. DOACs showed benefit over VKAs for most outcomes, of which major bleeding and all-cause mortality were most commonly reported. Edoxaban demonstrated a comparable effectiveness/safety profile to other DOACs and significantly reduced risk of major bleeding (hazard ratio [95% credible interval]: 0.67 [0.54, 0.84]) and intracranial hemorrhage (0.69 [0.51, 0.94]) versus rivaroxaban. CONCLUSION: This NMA provides valuable insights into the real-world effectiveness and safety of DOACs and VKAs in Europe, supporting clinical decision-making and adding to the existing evidence base from clinical trials.
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Cichewicz et al. (2025) conducted a meta-analysis in Non-valvular atrial fibrillation (NVAF). Edoxaban vs. Rivaroxaban was evaluated on Major bleeding (HR 0.67, 95% CI 0.54-0.84).
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